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Discussion

Does anyone actually like working in the rehab unit?

Curious if there is anyone out there who feels they have mastered the rehab unit in long term care. I have been working in rehab for about a year and half now. I would compare it to being on a rollercoaster. But the with more lows than highs. 

For the rehab unit I work in we get mostly hip fractures, CHF exacerbation, covid recovering patients, asymptomatic covid patients, tube feeds, wounds, and other miscellaneous things. Majority hip fractures though. Often the above are also fall risks, increased confusion secondary to their current condition. 

The part I struggle the most with is that they seem to not care what we are actually physically capable of handling. The social worker seems to plan all the discharges on the same day. Discharging 3-5 residents in the morning during our morning medication pass. Then in that same day the admissions team will schedule 3 admissions all scheduled to arrive the last 3-4 hours of my shift. The nursing skin assessment and head to toe nursing assessment are supposed to get done within the first 2 hours of arrival. Then there is of course code status paper work, consent forms for antipsychotic/antidepressants/antianxiety, fall risk, wandering risk, and calling the doctor to review medications over the phone, putting med orders into PCC, and finding a kind soul who has time to double check medications. Is it just me or is rehab super dysfunctional? Like not physically possible, and sometimes unsafe.... I have been relentlessly working my tail end off, working as efficiently as possible while tending to all my resident's needs. The worst part is when you admission arrives and is super painful right off the bat... It is a process to get medications reviewed, input, and activated. 

On top of this there is of course all the medicare charting for the residents currently there. I am grateful that we have 16 beds, I have heard of other rehab units having more in other LTC facilities. But they are all rehab patients. The other sub acute rehab units in my town have a mixture of LTC residents and rehab patients in their rehab unit.

I also find it very frustrating carrying the portable nursing phone, because it rings non stop. I feel like a dang receptionist. I have huge empathy for the families, since covid the amount of phone calls I get during the day are near impossible to keep up with while juggling all my other responsibilities. Most of the time the calls are asking about the routine of the facility, and what they can expect their family members stay to consist of, or asking if can retrieve items dropped off up front, set them up for a window visit, set their family member up on the phone, and etc. All reasonable requests, but something anyone other than nursing staff could easily respond to. There is also a phone in the office that we are expected to check voicemails on, but the other nurses don't keep up with them so when I come in my shift there are 10+ voicemails unanswered and take forever to go through. 

Maybe I am being a little whiney, but it just seems so easy to add just one more thing to our plate, and it all adds up and takes away from actual patient care. And sometimes leads to errors being made. 

 

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    I want to add that all the other nurses in my unit feel the same way, and I have heard from CNAs that the nurses have left the floor in tears many times. The nurses I am in close contact with sometimes text while I am off and they are working that they are having a panick attack at work. Although I am glad to hear I am not the only one overwhelmed, and pushed past my limits, it sucks to know that we all feel this way, and have for months. It seems like this is considered the norm. And the DON says that is the nature of rehab. We often are work 2 hours past our 12 hour shift, do not have time to take break or even pee during our shift. All we get are nasty emails when things are missed or done incorrectly. I am all for taking responsibility and holding myself accountable. I am naturally very self critical, and have considered that to be one of my biggest down falls. However I can't help but feel that some of the errors are the result of an impossible amount of responsibilities and lack of support to complete these when getting slammed. It would be nice at the very least to get some recognition from management how much stress we are under, especially since covid. But instead they throw parties for each other, and lack empathy for their staff. 

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    Long distance (((hugs))) for you.

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    Yes, I liked it a lot and used my experience to go into wound care, MDS, and staff education.  Some of the stressors you describe also exist in acute care and other bedside jobs also.  For me, the key was having decent charge nurses/management.

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    I like it. But it seems like the volume of work in such a short amount of time is impossible. Especially when we get 3-4 admissions back to back toward the later end of our shift. What did you find helped during these busy times?

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    I enjoy working rehab units but it sounds like you need more support on the floor youre on. Unfortunately staffing is always put on the back burner. I don't know if this job sounds healthy for you, your other coworkers also feeling panic attacks sounds really miserable. I definitely have had very busy shifts where I don't pee either but we have to find a way to care for ourselves too. Who is your charge nurse/supervisor/unit manager? Can you talk to them? If support is impossible to find maybe it is time to seek a new job. Rehab floors give great experience- meds, time management, wound care, etc. Your mental health matters too.

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    On 5/1/2021 at 8:32 PM, suturethis said:

    I like it. But it seems like the volume of work in such a short amount of time is impossible. Especially when we get 3-4 admissions back to back toward the later end of our shift. What did you find helped during these busy times?

    Have a checklist of what needs to be done for each admission.  It is a 24 hour business and sometimes the next shift has to finish it (this requires management to support you and back you up on this!).  I always prioritized getting the assessments done, then orders.  Care plans can wait.  If you have more than 1 nurse on the unit, foster a culture of 'all hands on deck' for admissions no matter whose pt it is.  

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    • Author

    Thank you,

    I ended up cutting down my hours. I think I was getting burnt out, and started to have a negative attitude. I feel like I can add more hours later once I get my mojo back. I also work on the long term care side more, gives me a break from rehab.

    I appreciate your advice. I never know whether to start with meds vs assessments. So it is good to to hear your input. There is already a checklist provided for us, and I use it with every admission. 

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    First I would stop answering the phone for them, your priority is the residents. The BON is not going to care that you let the phone ring.  

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